Helical Tomotherapy® is a Safe and Feasible Technique for Total Scalp Irradiation

Cuccia, Francesco; Figlia, Vanessa; Palmeri, Angelo; Verderame, Francesco; Casto, Antonio Lo; Mannino, Mariella; Ferrera, Giuseppe

doi:10.4081/rt.2017.6942

Cited by 22 publications

(25 citation statements)

References 11 publications

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“…In an attempt to address this problem, the advanced technique of intensity-modulated radiation therapy (IMRT) is currently being utilized for total scalp irradiation in some institutions. In particular, some clinical studies concerning helical tomotherapy and rotational IMRT, typified by volume-modulated radiation therapy, have reported an excellent dose distribution that is homogeneous over the whole scalp while reducing the irradiated dose and volume given to organs at risk, such as the central nervous system (28)(29)(30). Although insufficient clinical data on patients treated with such advanced techniques have thus far been collected, these are novel and promising tools for total scalp irradiation.…”

Section: Future Prospectsmentioning

confidence: 99%

Radiation Therapy for Angiosarcoma of the Scalp: Total Scalp Irradiation and Local Irradiation

Hata

2018

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Section: Future Prospectsmentioning

confidence: 99%

Radiation Therapy for Angiosarcoma of the Scalp: Total Scalp Irradiation and Local Irradiation

Hata

2018

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“…The posterior double‐shell bolus is fixing the patient to the baseplate onto the Treatment coach. With the use of DSB technique, we achieved good dose homogeneity and conformity of the PTV and lower doses to the OAR, especially mean dose of the brain compared to the published data . Without the DSB application, the PTV can definitely exceed the patient's skin outline due to tumor invasion at the skin.…”

Section: Discussionmentioning

confidence: 70%

“…The main goal of this study was to provide a uniform dose (with the desired skin coverage) to the target (scalp/skull) while maintaining the dose delivered to the normal tissues as low as possible (compared to the published data) using linac based VMAT technique. This therapeutic goal cannot be easily achieved without the use of the DSB device because of the concave shape of the target, lesion at the skin (the objective was 100% coverage of the skin), and the doses to the OARs.…”

Section: Discussionmentioning

confidence: 99%

“…A dosimetric comparison between helical tomotherapy (HT) and conventional VMAT showed that HT allows the best target coverage and conformity with the lower mean dose to the brain . Most of the published articles with tomotherapy techniques claim good target coverage and lower‐mean dose to the brain in the scalp/skull radiotherapy treatment compared to conventional VMAT and IMRT. The linac‐based VMAT which is available almost in every cancer centers has greater potential to improve skin coverage, dose homogeneity, conformity, and reduce the mean dose of the brain with the application of 1‐cm‐thick bolus.…”

Section: Introductionmentioning

confidence: 99%

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Customized double‐shell immobilization device combined with VMAT radiation treatment of basosquamous cell carcinoma of the scalp

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Al-Ghamdi

Chantel

et al. 2019

J Applied Clin Med Phys

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Malignancies with a superficial involvement of the scalp/skull present technical challenges for radiation‐treatment‐planning, such as achieving skin coverage with the prescribed dose and with the desirable conformity, homogeneity, and lower brain dose. We report a radiotherapy treatment technique for a patient diagnosed with diffuse basosquamous cell carcinoma of the scalp and adjacent skull‐bone. This study presents the plan's quality parameters, patient's dosimetry, and patient's outcome. The patient was treated using volume‐modulated‐arc therapy (VMAT) and a double‐shell‐bolus full‐head device (DSBFD) designed for patient immobilization and better skin coverage. A VMAT plan was generated using an Eclipse treatment‐planning system for a prescribed dose of 60 Gy in 30 fractions. The treatment plan was analyzed to determine the conformity index (CI), the homogeneity index (HI), the target‐coverage, and the dose to the organs‐at‐risk (OARs). Skin‐doses were measured using optically stimulated luminescence (OSL) dosimeters. Clinical follow‐up was performed by the radiation oncologist during and after the course of radiotherapy. With regard to planning target volume (PTV) coverage, the V 95 was 99%. The measured and calculated dose to the skin was in the range 100–108% of the prescribed dose. The mean brain‐PTV dose was 711 cGy. The CI and HI were 1.09 and 1.08, respectively. The mean positioning accuracy for the patient over the course of treatment was within 2 mm. The measured accumulated skin dose and planning dose was agreed within 2%. Clinical examination of the patient 6 months after radiotherapy showed good response to the treatment and a 90% reduction in scarring. The DSBFD technique combined with RapidArc treatment was useful in terms of the target dose distribution and coverage. Daily patient alignment was found very precise, reproducible and less time‐consuming.

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“…Helical tomotherapy (HT) has also been shown to be a reasonable radiation therapy technique for TSI, owing to its ability to deliver tangential beams to any point on the scalp with no need for field matching [10][11][12][13]. Song et al [9] performed a dosimetric comparison of HT to 3DRT and VMAT and found that HT provided the best conformality of all 3 techniques and resulted in the lowest mean brain dose.…”

Section: Introductionmentioning

confidence: 99%

Proton Versus Intensity-Modulated Radiation Therapy: First Dosimetric Comparison for Total Scalp Irradiation

Sharma

Kowalski

McGovern

et al. 2019

International Journal of Particle Therapy

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Purpose: Total scalp irradiation (TSI) is used to treat malignancies of the scalp and face, including angiosarcomas, nonmelanoma skin cancers, and cutaneous lymphomas. Owing to the irregularity of the scalp contour and the presence of underlying critical organs at risk (OARs), radiation planning is challenging and technically difficult. To address these complexities, several different radiation therapy techniques have been used. These include the combined lateral photon-electron technique (3DRT), intensitymodulated radiation therapy (IMRT)/volumetric arc therapy (VMAT), helical tomotherapy (HT), and mold-based high-dose-rate brachytherapy (HDR BT). However, the use of proton radiation therapy (PRT) has never been documented. Materials and Methods: A 71-year-old, immunosuppressed man presented with recurrent nonmelanoma skin cancer of the scalp. He was successfully treated at our center with PRT to deliver TSI. A comparative VMAT treatment plan was generated and dose to critical OARs was compared. Results: We present the first clinical case report of PRT for TSI and dosimetric comparison to a VMAT plan. The PRT and VMAT plans provided equivalent target volume coverage; however, the PRT plan significantly reduced dose to the brain, hippocampi, and optical apparatus. Conclusion: TSI planned with PRT is relatively straightforward from a planning perspective and does not require a bolus. It also has the potential to decrease radiation therapy-related toxicity. However, PRT is relatively expensive and not universally available. The uncertainty surrounding the end-range of the proton beam is a consideration. Although there are potential disadvantages to using PRT for TSI, its use should be considered by treating radiation oncologists and referring physicians.

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Helical Tomotherapy® is a Safe and Feasible Technique for Total Scalp Irradiation

Cited by 22 publications

References 11 publications

Radiation Therapy for Angiosarcoma of the Scalp: Total Scalp Irradiation and Local Irradiation

Radiation Therapy for Angiosarcoma of the Scalp: Total Scalp Irradiation and Local Irradiation

Customized double‐shell immobilization device combined with VMAT radiation treatment of basosquamous cell carcinoma of the scalp

Proton Versus Intensity-Modulated Radiation Therapy: First Dosimetric Comparison for Total Scalp Irradiation

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